Monthly Archives: October 2015

Welcome to day 31, the last day in the #Write31Days challenge on mental health. The month has gone by with me discussing lots of mental health issues. I have shared information and personal experience and hope you’ve been able to get something out of it. You might recognize some experiences or features of mental health issues I have discussed. Today, I will share what you can do if you suspect you may have a mental health problem.

First, like many people, I consulted Dr. Google when I realized I might have a mental health problem. You have already gotten some information on mental illness if you’ve read any of my posts in this series. You being a blog reader means you are familiar with the Internet. If you don’t know where to find reliable information on mental health, Psych Central is a good place to start. This site also has a forum and chat room for support. Obviously, no-one can there is equipped to diagnose or treat you.

If you decide you might need to see a mental health professional, it is good to know where to start. In some countries, you can consult a psychologist or therapist without a referral. In others, like the Netherlands, you can go see a counseling psychologist for short-term treatment withut a referral, but if you have more serious mental health problems, you need your GP’s referral to go see a mental health professional.

If you see a mental health professional for the first time, it is advisable to take your questions and issues with you on a piece of paper. You may want to bring a friend or family member to the introductory session, but that’s up to you. Most mental health professionals will know that patients today consult Dr. Google and will help you find reliable information about your concern. Those who are overly arrogant and pretend they know infinitely more than you do, may not be suitable. On the other hand, I’ve heard that some professionals tell patients to do their own research and don’t offer directions. I don’t see that as okay either.

Don’t come into a mental health professional’s office announcing you are sure you have a condition you’ve read about on my blog, on Psych Central or elsewhere. Making a diagnosis takes more than the patient’s report of their symptoms. Competent mental health professionals will not take your reported symptoms at face value. It may seem as though a mental health professional does not believe you when they ask to speak to a family member or do some tests on you. This is not the case, but family members can provide information you may not see as the affected person yourself, and tests ask questions you may not have thought of. They also help the clinician get a more objective idea of what to diagnose you with, if anything.

If you do not feel comfortable with a mental health professional at first, it may be because you feel uncomfortable talking about your mental health. However, if you don’t click with the provider, it’s totally okay to say so and ask for a referral to someone else. Every competent mental health professional should be okay with this.

Welcome to day 30 in the #Write31Days challenge on mental health. Today, I discussed the details of the mental crisis that I had in 2007 with a nurse. This helped me feel heard but it also was a bit unsettling. I vividly remember many of the details. I feel compelled to share my story here, but I don’t know how safe a public blog on the Internet is to do so. I shared the details in a post on my old blog (which can still be more easily found by googling my name than this blog) about a month after the crisis happened. I published the raw story back then, complete with every detail of where I was and what I did. I edited it more than a year later for fear it’d ruin my chances of ever having a normal life. If future employers (of which I think I’ll have none) ever read that I’m a nut case and spent eight years in a mental institution, they’ll reject me no matter how vividly I describe the crisis that led to said institutionalization. That being said, the original story was quite badly written. I don’t want to read even the edited version now. I’ll just share what I feel like sharing now.

I remember the crisis state started right after daylight saving time ended on October 28, 2007. Of course, I was spiraling down into crisis from the moment I started livign on my own in August and I had a minor crisis about once a week. The week of October 29, I started completley losing my mind. I wandered about in the dark each evening. The police took me to the police station a couple of times that week and called the crsis service, but they couldn’t do anything.

In the afternoon of October 31, I was called by the crisis service. I still remember the name of the crisis service nurse calling me and if I ever run into her again, which is unlikely, I’m not going to be pleased. She told me that I just had to find ways to distract myself and that a hospitalization would mean I needed to go back on medication. (I’d quit an antipsychotic three weeks prior. No-one later on drew the connection.) I didn’t care about going on medication one way or the other, but I couldn’t mutter a proper response.

On November 1, I took a trip to my parents’ city to collect a landline phone. I don’t have a clue why I had to sleep over there for a night just to collect a phone. On the way back to my city the next day, I had a huge meltdown. This wasn’t unusual for me when returning to my city from my parents’, but for the first time, the railroad service employee who was assisting me to get on the train back to my city, called the police. I hardly realized I was speaking to the police when they told me to leave the station. I wasn’t sure what to do at first, so wandered around. I remember somoene, no clue who, told me that if I could behave, I could come back to the station and get on the train to my city.

I decided to go to the training home which I’d been a client of before going into independent living. I was allowed in, but once the staff found out the police had been called on me, they asked me to leave. I can’t remeber what I did throughout the afternoon. I was supposed to have an early train, but didn’t end up in my ultimate crisis till 8:00 PM. I remember getting some French fries at a cafeteria near the training home and calling my independent livign support worker that I’d forgotten to pay my rent for November the day before.

A housemate from the training home offered me to stay with her for the night so that we could find a solution the next morning. The staff went into her apartment and told me to leave. They initially gave me some time, but I left instantly and had the hugest breakdown I’ve ever had. I was hardly aware of my surroundings as I told some people’s voicemails that I was going to commit suicide. I inferred the time from what the bus driver, on whose bus I’d embarked, told the police. It was the 8:01 PM bus around the eastern part of the city (in that city, buses go in circular routes or at least they did back then).

I was taken to the police station by the police again. This time I was in my parents’ city so the route to crisis services was even longer. The police had to call a community physician who was the most umempahtetic jerk of a doctor I’d met by that time. (I later was treated by an authoritarian psychiatric resident, but she never had to talk to me in the midst of a crisis.) The doc told me I was making people feel responsible. While I can see eight years on that he was right, I couldn’t grasp this back then. I don’t remember my response. The community physician called the crisis service. I have recurrent dreams about the psychiatrist, the only one whose name I remember. In my dreams, I run into her again as I get treated at the mental health agency near the tiny village I’m moving to.

I am a million times thankful that this psychiatrist didn’t stick the BPD diagnosis on me, even though in retrospect my crisis could be interpreted as a typical BPD thing. Instead, she talked to me – she showed much more empathy than the community physician and eventually labeled me with adjustment disorder, which basically means an extreme response to stress. She suggested I be admitted and right away clarified that a suitable living solution would need to be found for me while I was in the hospital. No-one could’ve known back then that it’d take eight years and I’d be going to live independently once again after that.

Welcome to day 29 in the #Write31Days challenge on mental health. Phew, we’re almost done. I truly find it a challenge and unfortunately don’t find it particularly rewarding.

Today, I’ll give you a glimpse into my unquiet mind by describing what it feels like tohave my mental illness. I have been diagnosed with borderline personality disorder, which is characterized by self-regulation difficulties. It also overlaps with other disorders.

Once, years before I had been diagnosed with any mental illness at all, I read a description on a Dutch site of the “borderline feeling”. It described a starting point at which you are feeling fine, or at least appearing as though you are fine. Then, a minor annoyance occurs. You start feeling frustrated, angry, infuriated. Then you feel sad, depressed, depserate. Fear and then panic also comes in. Finally, all feelings tumble over each other and create a big emotional whirlwind. That’s what the experience of BPD is like.

I can illustrate this with an example. This afternoon, I was feeling slightly on edge because it was time to make afternoon coffee and no-one was available to assist me. Then, when I noticed the nurses were flipping through some seemingly unrelated photos at the nurse’s station, I completely lost it. They had told me they were busy and now they were just chattering! I can’t even remember how the situation progressed, but within minutes I was banging my head, screaming and then ran off. When I came back to the unit (I had the sense of rationality to find my way back myself), I accused the nurses of faking being busy and ignoring me. They had truly ignored me (or been oblivious to me at least) when i stood at the nurse’s station and I still cannot be sure what thing was keeping them so busy. That being said, I couldn’t politely ask them whether they truly didn’t have time to help me make coffee.

We had a group discussion, in which I was again relatively calm. Then we had dinner, after which I went on the computer for a bit. I still was feeling slightly on edge but not over the edge. I wanted to talk to the nurse, so made use of my daily talk time to discuss my tension. However, I couldn’t get it out clearly what I was feeling and why. At that point, all emotions started coming together and I became angry and depressed and fearful at the same time. I went outside, accompanied by the nurse, to blow off some steam.

Usually, this feeling I had in the evining for me is triggered by some flashbacks or relivings of past “trauma”. I put that between scare quotes because the events I am reliving can be relatively minor. However, they can cause distress nonetheless.

During such episodes I also often feel dissociated. I used to completely regress into a child mode, but now I just feel as though I’m small and start speaking or babbling incoherently but don’t fully act like a child.

When an episode is severe, I may resort to self-destructive behaviors such as binge eating or self-injury. Usually, these behaviors temporarily relieve the tension but obviously they aren’t the solution. I often relapse soon after I engaged in destructive behaviors. With PRN tranquilizers, especially benzodiazepines, the same used to be true: they temporarily calmed me down, but when they wore off, I was increasingly agitated. Research shows that borderlines often become more agitated and may become aggressive when given benzodiazepines, because benzodiazepines reduce their anxiety and thereby their impulse inhibition. I do not personally experience this.

Welcome to day 28 in the 31-day writing challenge on mental health. Today, I will be discussing dissociation. I used to have a diagnosis of dissociative identity disorder, but dissociation is also common in post-traumatic stress disorder and borderline personality disorder.

Dissociation refers to a detachment from reality: disconnection from one’s surroundings, one’s own body, one’s mental processes or one’s identity. there are five different domains of dissiociation:

Depersonalization: a disconnection from one’s own body or mental processes. People who experience depersonalization feel “unreal”.

Derealization: a disconnection from one’s environment. The world around people who are derealized seems unreal or vague, as if looking through a glass wall.

Amnesia or memory loss. People who experience dissociative amnesia can be triggered by things that remind them of an unpleasant memory, but they do not remember the unpleasant event. Amnesia can also refer to “time loss”, where the person does not know what happened during a specific time period. Identity amnesia refers to a person not remembering who they are.

Identity confusion. This refers to being unsure of who one is. I have always believed that everyone has a level of identity confusion, but when I did a structured interview for dissociation, it appeared as though this isn’t really normal.

Identity alteration or “switching”. This refers to a person becooming “someone else”. This ccan be apparent on the outside, like by the person having a change in non-verbal communication that is unlike them. It can also be apparent on the inside, where the person just feels as though they’re “someone else”.

Dissociation is different from psychosis in that people who dissociate are still aware of reality. Most people with dissociative experiences do not experience delusions or hallucinations, though a PTSD flashback coupled with dissociation can look like it. At least in my case, I’ve appeared quite disorganized and out of my mind when in a flashback.

Dissociation to a certain extent is normal. Most people on occasion get “lost” in a book or movie, for example. When dissociation is more severe, you may have a dissociative disorder. There are several different dissociative disorders.

Depersonalization/derealization disorder is characterized primarily by depersonalization and/or derealization. This disorder can only be diagnosed if the depersonalization/derealization is not due to another mental disorder, such as a panic disorder.

Dissociative amnesia is primarily characterized, as the name suggests, by amnesia.

Dissociative fugue. This is a subtype of dissociative amnesia where the affected person travels away from their home or work and has amnesia for their entire life prior to travelling away. They also often adopt a new identity.

Dissociative identity disorder is characterized by both amnesia and dissociative phenomena affecting identity, ie. identity confusion and alteration. DID is considered to be the most severe dissociative disorder.

Depersonalization and derealization can, as I said, be part of another mental disorder, such as panic disorder. There is also a subtype of PTSD which is characterized by depersonalization and derealization. Other causes of depersonalization and derealization include stress and certain substances, such as marijuana.

The other dissociative disorders are believed to be trauma-based. Treatment involves psychotherapy. The psychotherapeutic treatment of DID consists of three phases:

Stabilization. In this phase of treatment, a person learns coping skills to deal with flashbacks, keep themself safe and stay grounded.

Processing the trauma that caused DID.

Integration. This can refer to merging of the alters, but also to rehabilitation.

In 2011, Onno van der Hart, Kathy Steele and Suzette Boon published a manual for skills training in the first phase of DID treatment called Coping with Trauma-Related Dissociation.

Welcome to day 27 in the #Write31Days challenge on mental health. Today, I will describe what a typical day is like living with my mental illness and as a psychiatric inpatient.

Usually, I am awoken by the staff at around 8:30 AM. They give me my mornign medication. My morning meds consist of my antipsychotic, a capsule of Prisolec for my reflux, and vitamin D. I get dressed and go to the living room for breakfast. The nurses usually prepare my breakfast, because I cannot put topping on my bread or mix yoghurt and muesli without making a big mess. I usually drink a cup of coffee and then go to my room to check my E-mail. In the institution, we have WiFi only in the front room, but I have subscrption Internet access in my room.

I generally go to day activities at around 9:30. Some people in my institution have fixed times when they have to go to their workshops, but I do day activities on the ward across from mine. You can dorp in there whenever you want (provided you don’t have to go to work elsewhere). I often stay for about an hour.

Morning coffee break is at 10:00 AM. At around 10:30, the domestic service worker usually delivers fruit, bread and other foods to the living room. On my side of the unit, the cupboards for getting food are not locked during the day, so you can get bread whenever you want. On the other side and on most other units, the cupboards are locked. There are pros and cons to each. A pro to keeping the cupboards open is it allows patients more freedom to eat when they feel hungry. A drawback is many patients make a mess out of the kitchen when they get their food. Another reason cupboards are locked, according to the nurses, is precisely to prevent us from eating whenever we want. I honestly believe this is a stupid rule: you shouldn’t have meal times enforced in the outside world either.

Lunchtime is at noon. Usually again, a staff member prepars my food. We used to have hot lunches, but the microwaved meal got moved to the evening. I remember at the blindness rheabilitation center, the patient councilwould have to be consulted on such decisions, but patients were not involved in this decision here.

I usually sleep for about an hour after lunch. At 1:45 PM, the early evening shift comes on. There are three nurses on the morning shift and two on the evening shift. When the early evening shift comes on, there may be time for me to be taken on a walk. I am trying to unlearn my habit of going to the town store everytime we go for a walk, but I’m so far not too successful.

I may go to day activities in the afternoon again. Day activities close at 4:00 PM. I will then go on the computer for a bit before making coffee for my fellow patients at 4:30. I get help making coffee, but do most things myself.

At 5:30, we have dinner. We used to be able to choose between about four microwaved meals that were served individually. Probably because of budget cuts, the unit moved to meals delivered in bulk. I cannot say anything good about the bulky meals. The biggest reason I hate them is that I’m a picky eater and all choice is gone. This evening, I forced myself to taste some mashed potatoes, but I could hardly keep them down.

In the evening, I usually go on the computer until around 7:30. We then get coffee again and watch the news. That is, when the unit’s soap opera binge watcher hasn’t switched the channel to some cheap series. She usually does. We have two TVs, one in the living room and one in the front room, but at 8:00PM, except when the head nurse works, they’re both tuned in to the Netherlands’ top soap opera. When the head nurse works, she insists on watching the eight o’clock news.

I usually have a chat with the evening nurse at around 7:45. This is so that, if I’m stressed during the day, I can vent off my issues before it escalates usually early at night.

Evening medication time is at 9:00 PM. We often get coke then too. At my former unit, we only got coke on week-ends, but here we get it pretty much everyday. On some days, we get chips or other snacks. Most people eagerly await their evening medicine even if there aren’t any snacks. My evening medication is only my antidepressant. I should be switching birth control, which I take with dinner, to 9:00 PM, so that I have the two pills at the same time.

I go to bed at anywhere between 9:30 PM and midnight. Today, I was on the phone with my sister for hours and had yet to complete this post, so it’ll probably be past midnight that I’ll be in bed. The staff sometimes have to remind me to shower before bedtime, but usally now I can think of it myself.

Welcome to day 26 in the #Write31Days challenge on mental health. Today, my husband and I accepted the house to the right side of Arnhem we were offered on Thursday. I am therefore cheating a bit with the 30-day mental illness awareness challenge and choosing the question from day 29. Actually, it isn’t cheating at all since I never followed the challenge to a T. Anyway, for day 29, the question is about some of your goals with regard to your mental health.

My main goal that I’ve been working on for the past nine months now is to eventually be able to move in with my husband. Since we’re moving to the right side of Arnhem in probably less than a month, you may think there’ll be a bit of a delay in finding me care, but things never went that fast anyway. I hadn’t had an intake interview with supported housing on this side yet. Neither had a definite decision about allocated care hours been made. Remember, we’ve been working on this goal for nine months. Things go that slowly.

One factor in this slow-going process was the fact that my treatment team and I were waiting for the consultation with the autism center we didn’t have till the middle of May. Looking back, there’s not a single thing this center has been helpful with. Another factor, however, was the fact that my husband and I had been planning on moving for months. Even though my psychologist said she’d make arrangements as if we weren’t going to move, I at least have a bit of hope (or illusion) that now that the elephant is out of the room, we can actually start making arrangements for my care.

Apart from preparing for living with my husband, I don’t have any real goals for my mental health treatment right now. However, living with my husband requires a greater level of emotional self-control than living in an institution with 24-hour care. My husband works irregular hours and may be working long days. I won’t have support available when I need it right then during my husband’s work hours. If a support worker will be able to come out to the tiny village on call at all, it’ll take at least fifteen minutes if they can leave right away. Fortunately, I am relatively good now at spending time without care if I know at what times I’ll be abe to enlist a support worker or my husband will be home. I still need to work on improving this ability, because my husband cannot always tell when he’ll be home.

When I do live with my husband, additional goals for my mental health will have to do with other aspects of emotion regulation. I want to finally learn to kick the binge eating beast, for example. There are undoubteldy other negative coping skills I need to learn to replace, but I can’t think of them right now. In short, I hope to eventually be able to participate in day activities and live with my husband without too much emotional turmoil or behavioral outbursts.

Welcoem to day 25 in the 31 Days of Mental Health. Today, I’m inspired by yet another question from the 30-day mental illness awareness challenge. For day 25, the question is about your opinion on force or coercion in mental health.

I used to be a strong opponent of any form of coercion in mental health. I remember once in late 2007, when I was still on the acute unit, a fellow patient being medicated against their will. I saw this as a particularly nasty violation of the patient’s human rights, worse than for example seclusion. Now I know that for some people, if they have to choose between seclusion and rapid tranquilization, their choice is not always seclusion.

I used to believe, in my naivety that there is always an alterantive to force in mental health. I still believe there is in most cases. For example, studies of involuntary outpatient treatment don’t compare the programs to the same level of care but without the component of force. If they did, maybe it’d be shown that there is no advantage of forced treatment, and it is just the intensity of care that makes the difference. In this light, I remember one particularly poignant interaction I had with a nurse on the acute unit. She said that I’d be secluded if I needed more care than they could provide. Indeed, involuntary outpatient treatment is generally seen as a way of averting hospitalization. Now I’m not a big fan of psychiatric hospitalization, but I cannot help but believe involuntary outpatient treatment is just a convenient (for the providers and the government) way of saving money. So are most forms of force in mental institutions, as my interaction with the nurse illustrates.

Of course, a few people cannot be kept safe even with constant one-on-one attention, assuming the government would allow this. A notable example is the case of Brandon, a young man who had been restrained in his institution for people with developmental disabilities for years when the newspaper got word of it in like 2010. I was infuriated at such inhumane treatment as restraining a person for years, but my husband and many other people I spoke to countered that there simply was no alternative. Medications hadn’t helped (and besides, that’d be another form of force) and Brandon was so aggressive that he’d attack anyone coming close.

That being said, still, in many cases, force in mental health and developmental disability care is used as an alternative to proper care. I remember one example that I read about at the time Brandon’s case was in the news. A proponent of electroshocks as aversive therapy for people with severe self-injurious behaviors presented the case of a person who was hitting his eyes so vigorously that he was at risk of becoming blind. He described the situation of the nurses conferring at the nurse’s station while the man was blinding himself in the next room, adding something like: “And what quality of life does a person with an intellectual disability who is also blind have?”

I cannot begin to tell you all the things that are wrong in this situation. Nurses sit at the nurse’s station conferring (or drinking coffee) way too much rather than taking care of their patients. We do not know whether one-on-one attention would’ve prevented this man from blinding himself, because there was none. INstead, his treatment team chose to set him up with a shock machine. In addition, I totally understand a sighted, intellectually capable person’s judgment that an intellectually disabled person who is blind has no quality of life. However, the proponent of shock therapy hardly considered the effect whatever causes this person to self-injure has on his quality of life, possibly multiplied by the effects of electroshocks. We do not know whether the person in question had a painful medical condition. I assume the cause of his self-injurious behavior was unknown or could not be taken away, but I’ve heard parents and professionals advocating for aversives or restraints when the cause of problem behavior is known and can be removed.

I do use some double standards though. Being in a mental institution myself, and especially having seen some of the more severely mentally ill people, I have lost some of my naivety regarding forced treatment. Perhaps less self-righteously, when soemone bothers me, I’m happy to have them secluded, restrained or medicated. There are some people on my unit who are very regularly verbally aggressive or simply very annoying when psychotic. In those cases, though I would like to say I oppose force, I’ve actually been relieved when the nurses gave these people some PRN medication, often with only some sembleance of consent. I would like to believe that the guys who constantly talk to their voices are actually helped by a low-potency neuroleptic, but at least I do not know whether these people are bothered by their voices and if so, whether the PRN medication actually quiets their voices. I should care, but when it’s past 10PM and I want to sleep, quite frankly I don’t.

Welcome to day 24 in the #Write31Days challenge on mental health. As I said about a week ago, I’d write a post on schizophrenia and psychosis someday in this series. Today the day has come to write about this category of mental disorders. Most people admitted to psychiatric hospitals, and certainly most who are there long-term, have some form of a psychotic disorder. I do not and personally I find psychosis one of the most bewildering mental health symptoms.

Psychotic disorders are characterized by symptoms in one or more of the following five domains:

Delusions: fixed beliefs that do not change when the sufferer is presented with conflicting evidence. An example is the unfounded belief that one is being persecuted. Delusions are classified as bizarre when they are not understood by people from the sufferer’s culture and do not derive from ordinary life experience. In other words, a non-bizarre delusion is about something that could technically happen to the sufferer; a bizarre delusion is about something that is truly impossible. An example of a bizarre delusion is the belief that an outside force has removed one’s internal organs and replaced them by someone else’s.

Hallucinations: sensory perceptions (eg. smelling, hearing or seeing something) that occur without an external stimulus. Hallucinations are as clear and vivid as ordinary sensory perceptions. Hallucinations may occur in any sensory modality, but auditory hallucinations are most common in schizophrenia and related disorders. (Visual hallucinations are more common in neurological conditions.)

Disorganized thinking (speech). Formal thought disorder (disorganized thinking) is generally apparent through a person’s speech. For example, a person may switch from one topic to another (derailment or loose association). Rarely, a person’s speech may be so severely disorganized that it is barely comprehensible. These people’s speech is referred to as “word salad” (thhat’s the actual term used in DSM-5).

Grossly disorganized or abnormal motor behavior. An example of this is catatonia, a marked decrease in reactivity to the environment. People may “freeze” in a (usually odd) position. Other examples are complete lack of speech (mutism), repetitive, purposeless movements or repeating someone else’s words (echolalia) or actions (echopraxia).

Negative symptoms. These include reduced emotional expression and avolition. Avolition is a decrease in motivated, self-directed, purposeful activity. People may sit for hours and not be motivated for occupational, social or even simple household activities. They may therefore appear lazy.

Psychotic disorders may affect only one domain of symptoms. For example, delusional disorder is characterized by delusions only and no other psychotic symptoms. Sometimes, a person experiences more severe psychotic symptoms but the symptoms disappear within a month. This is called a brief psychotic disorder.

Schizophrenia is the most severe form of psychotic disorder. Individuals with schizophrenia experience symptoms in at least two of the domains listed above most of the time over a period of at least a month (or less if successfully treated). At least one of these symptoms must be delusions, hallucinations or disorganized speech. Since the onset of their symptoms, their functioning has declined significantly relative to their pre-illness level of functioning (in children or adolescents, consider failure to meet expected achievements in functioning). Even if the active phase of psychosis has subsided after a month, signs of disturbance remain for at least six months. If a person has residual symptoms for less than six months, they should be diagnosed with schizophreniform disorder.

The course of schizophrenia includes an active phase (at least one month during which at least two psychotic symptoms are present). This active phase may be preceded by a prodromal phase and followed by a residual phase. During the prodromal and/or residual phase, a person may experience only symptoms in one domain (usually negative symptoms), or they may experience two ore more psychotic symptoms but in a less severe (attenuated) form. Attenuated psychotic symptoms are symptoms that are similar to hallucinations, delusions etc. but are not full-fledged. Examples include odd beliefs or unusual perceptual experiences. Almost everyone experiences these at times. They become significant when they appear regularly and interfere with a person’s daily functioning. Some research shows that having attenuated psychosis symptoms is a risk factor for actual psychosis. However, there is no evidence so far that antipsychotics can prevent full-fledged psychosis in people who have only experienced attenuated symptoms.

Welcome to day 23 in the #Write31Days challenge on mental health. Today, I’ll focus on another question in the 30-day mental illness awareness challenge. For day 23, the topic is your opinion on therapy. I will share my experiences of therapy and my opinion on various approaches. I have decided to include both traditional psychotherapy approaches and non-verbal approaches.

I had my first experience of therapy as a child, when I had four sessions of play therapy. I didn’t like the therapist, didn’t have insight into my problems, and four sessions obviously wasn’t enough to garner any results. In hindsight, my play behavior did show my problems with rigid thinking, emotion regulation and behavioral control. For example, I’d throw out the dollhouse dolls with purple hair because “people don’t have purple hair”. I also preferred to play with toys that allowed me to show anger, such as toy guns. One vivid memory I have is of me trying to overflow the water tray. The therapist did show me why it wouldn’t work, but I tried anyway.

My first experience with verbal therapy was when I was nineteen and attending the rehabilitation center for the blind. Once again, I didn’t like the therapist, who appeared a bit inpatient towards my difficulties adjusting to blindness and misunderstanding of my social ineptitude. She tried to offer practical advice, while I felt I needed to process the rollercoaster ride that my life had become. Of course, time constraints – I had only about twelve sessions -, prevented us from going deeper.

During my first sixteen months in the psychiatric hospital, I didn’t have a psychologist. I did do movement therapy, which helped me greatly to release my emotional tension. It was here that I learned to rate my distress level – I came up with a system myself. Thhat being said, when later people asked me to rate my distress level, I was often stuck. This moveement therapist I had at the acute ward was one of the more helpful therapists I’ve had.

At the resocialization ward, I tried cognitive-behavioral therapy for a bit. It hardly worked, because I and my therapist agreed I had good reason to be anxious. Then, when I was diagnosed with DID and PTSD, the therapist pushed me to try EMDR, but I resisted. I didn’t have that severe PTSD symptoms, after all, and did have quite a bit of trouble with self-regulation and dissociation.

When I moved to my current institution, I got diagnosed with BPD. My therapist’s expertise was schema-focused therapy, an approach I’d wanted to use for a while. Unfortunately, it didn’t work out. The therapist told one of my parts, who hides her inner weakness behind a stubborn attitude, that she’s a “punitive parent” and needs to disappear. I strongly feel that each part of my personality has a function, so this dismissive attitude didn’t fit me well. Besides, though I learned some from the book the therapist recommended, most of the information was just a bit too abstract.

This therapist left in 2014 and I’ve had a new psychologist for a little over a year now. With her, I focus on supportive counseling and rehabilitation. I find this is most constructive. I do hope that, in the future, I can get some formal psychotherapy again. I have a dialectical behavior therapy self-help book, which is quite interesting. Then again, I find it hard to make a long-term commitment to sticking to one thing to focus on. That is probably the main thing keeping me from engaging properly in psychotherapy.

My husband and I have been in the process of a possible move for a few weeks. In fact, we’ve been contemplating moving for months. Last week, however, my husband informed me we’re high on the housing corporation’s list for a house in a tiny village on the “right” side of Arnhem (that is, east from it of course). My husband has been wanting to move back to that area ever since we moved into our current apartment in 2012. Today, we got the housing corporation’s green light for a visitation, at which point we can decide whether we want the house or not. With the possible move coming so close, my husband started worrying about the possibility of me getting home care in a tiny, rural village. This gets me to today’s topic in the #Write31Days challenge on mental health: the mental health care system in the Netherlands. I will focus on adult care, because it’s complicated enough without adding in the Youth Act and what not.

There are basically three laws governing mental health care in the Netherlands. First is the Long-Term Care Act. The Long-Term Care Act covers institutional care that is essentially deemed lifelong. Examples are nursing homes, group homes for people with developmental or physical disabilities, or psychiatric supported housing placements. Originally, all people requiring long-term, institutional care because of a disability or illness were covered, except for those with psychiatric illnesses. Apparently, the government thought that a psychiatric illness cannot possibly be lifelong. Before the Act took effect, however, this problem was solved. Now, if a mentally ill person has been in inpatient treatment for three consecutive years, they may qualify for institutional care through the Long-Term Care Act. I have yet to find out whether, should I fall apart while living with my husband and need to be institutionalized, I’ll first need three more years of inpatient treatment before I can go into supported housing. After all, I already got those three years of treatment.

Next is the Health Insurance Act. Health insurance is mandatory in the Netherlands and, though insurance companies are private, they cannot turn anyone down for the “basic package”. Basic health insurance covers GP visits, care by medical specialists, most medications, hospitalization, and other care deemed necessary. Outpatient mental health care, partial hospitalization and the first three years of inpatient mental health treatment are covered by basic health insurance. So are most but not all psychiatric medications. For instance, benzodiazepines are not covered except if the patient requires “high doses” of them because of “severe mental illness” (or some other, non-psychiatric indications). I assume they essentially mean that it’s okay as long as the patient needs chemical restraint.

The final law covering mental health is the Community Assistance Act. This law is implemented by each local government, so each locality gets to decide which people qualify for funding for care. They also decide whether people have to pay a copay. The Community Assistance Act covers housekeeping services, day activities and independent living support, as well as short-term institutional care and respite care. I will need day activities and most importantly independent living support through the Community Assistance Act. Whether you get care and, if so, how much is determined through a “kitchen table meeting” with a “social consultant”. Family members are supposed to sit at the kitchen table too, because they too are expected to fulfill some care duties for their disabled or ill loved one. I’ve heard crazy examples where children are required to do housework because their parent is disabled. I don’t object to chores, but the local government shouldn’t assign them in my opinion.

It is the Community Assistance Act that is worrying me and my husband most in preparation for the possible move. I mean, my health insurance won’t change but my local government will. I trusted the social consultant with the local government in our current town, which happens to be in the same municipality as the institution. That will change if we move to the tiny village, because I’ll stay in my current institution whilst preparing for home support. Not that there is an institution in the tiny village municipality anyway. What this means is, my social worker, my husban and I will have to negotiate with a social consultant who isn’t familiar with my current care situation. Besides, like I said, I trust my current social consultant and you never know who you’ll be stuck with next. Of course, my current social consultant hasn’t made any final decisions yet, so that could be a disappointment too. I E-mailed my social worker asking her to get an idea of care in the municipality we may be moving to. I did a quick read of the municpality website and found out they mention the tiny village in their allocation of social consultants, so I assume this means there must be possibilities.